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A historical perspective of MDR invasive pneumococcal disease in Spanish adults
Jordi Càmara1,2, Inmaculada Grau2,3, Aida González-Díaz1,2
1Microbiology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, Barcelona, Spain.
Objectives:
To analyse the clonal dynamics and clinical characteristics of adult invasive pneumococcal disease (IPD) caused by MDR and penicillin-non-susceptible (PNS) pneumococci in Spain.
Methods:
All adult IPD episodes were prospectively collected (1994-2018). Streptococcus pneumoniae isolates were serotyped, genotyped and tested for antimicrobial susceptibility. Changes in the incidence of IPD were analysed and risk factors contributing to MDR were assessed by logistic regression.
Results:
Of 2095 IPD episodes, 635 (30.3%) were caused by MDR/PNS isolates. Over the study period, the incidence of MDR/PNS-IPD decreased (IRR 0.70; 95% CI 0.53-0.93) whereas that of susceptible isolates remained stable (IRR 0.96; 95% CI 0.80-1.16). A reduction of resistance rates to penicillin (-19.5%; 95% CI -37% to 2%) and cefotaxime (-44.5%; 95% CI -64% to -15%) was observed. Two clones, Spain9V-ST156 and Denmark14-ST230, accounted for 50% of current resistant disease. Among current MDR/PNS isolates, 45.8% expressed serotypes not covered by the upcoming PCV15/PCV20 vaccines. MDR/PNS episodes were associated with older patients with comorbidities, nosocomial acquisition and higher 30 day mortality. MDR/PNS pneumococci were not independently associated with 30 day mortality in multivariate analysis [OR 0.826 (0.648-1.054)].
Conclusions:
Our study shows an overall reduction of MDR/PNS isolates in adults after the introduction of pneumococcal conjugate vaccines. However, a significant proportion of current resistant isolates are not covered by any of the upcoming PCV15/PCV20 vaccines. The burden of resistant disease is related to older patients with underlying conditions and caused by two major clones. Our data show that MDR is not a statistically significant factor related to increased mortality.
Insights
Invasive pneumococcal disease (IPD) caused by multidrug-resistant (MDR) and penicillin-non-susceptible (PNS) Streptococcus pneumoniae has decreased in Spanish adults. However, emerging resistant strains are not covered by new vaccines, and disease burden is linked to older patients with comorbidities.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Invasive pneumococcal disease (IPD) remains a significant public health concern, particularly strains exhibiting multidrug resistance (MDR) and penicillin non-susceptibility (PNS).
- Understanding the clonal dynamics and clinical characteristics of MDR/PNS *Streptococcus pneumoniae* is crucial for effective treatment and prevention strategies.
Purpose of the Study:
- To analyze the clonal evolution and clinical features of adult IPD caused by MDR and PNS pneumococci in Spain.
- To assess trends in MDR/PNS-IPD incidence and identify risk factors associated with multidrug resistance.
Main Methods:
- Prospective collection of adult IPD episodes from 1994-2018 in Spain.
- Serotyping, genotyping, and antimicrobial susceptibility testing of *Streptococcus pneumoniae* isolates.
- Analysis of IPD incidence trends and logistic regression for MDR risk factors.
Main Results:
- 30.3% of 2095 IPD episodes were caused by MDR/PNS isolates.
- Incidence of MDR/PNS-IPD decreased significantly, while susceptible IPD remained stable.
- Resistance rates to penicillin and cefotaxime declined; two clones (Spain9V-ST156, Denmark14-ST230) dominated current resistant cases.
- 45.8% of MDR/PNS isolates carried serotypes not covered by upcoming PCV15/PCV20 vaccines.
- MDR/PNS episodes were associated with older patients, comorbidities, and nosocomial acquisition, but not independently with 30-day mortality.
Conclusions:
- The introduction of pneumococcal conjugate vaccines has led to an overall reduction in MDR/PNS isolates in adult IPD.
- A substantial proportion of current resistant strains are not covered by upcoming vaccines, posing a future challenge.
- The burden of resistant disease is concentrated in older individuals with underlying health conditions and driven by specific clones.
- Multidrug resistance was not found to be an independent predictor of increased 30-day mortality in this cohort.
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